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INTRODUCTIONGroup B Streptococcus infection in pregnant women is a fatal and life-threatening condition as it has a tendency to cause septicemia in neonates.1 It is alarming to know that GBS infection is linked with an increased risk of chorioamnionitis as well as neonatal septicemia. 2,3 GBS is a Gram positive bacteria also known as Streptococcus agalactiae. They are often found in the vagina, rectum, urinary bladder and intestines and isolated from body fluids like CSF, blood, urine and vaginal secretions. They tend to be asymptomatic but can potentially be lethal. 15-45% of all pregnant women are believed to be colonized with GBS and 20-40% of these are colonized during labour. In 1-2% of the pregnant women infected with GBS, the infection can be passed on to the fetus and this can prove to be fatal. Though rare, the neonate usually acquires GBS infection from the mother during labour. Most infants will present with illness shortly after birth and 90% have been found to show clinical signs and symptoms within 24 hours of life. 4,5 To deal with this situation, a routine screening for GBS may be offered to all pregnant women at term gestation. 6 The likelihood of subsequent pregnancies being affected is 38% in women with a history of GBS ABSTRACT Background: Group B Streptococcus (GBS) infection in pregnant women is a major concern as it causes septicemia in neonates which is fatal and potentially life threatening. Objectives of present study were to study the distribution of Group B streptococcus infection among pregnant women at term, to understand if penicillin is still effective as the drug of choice, to determine the alternate drug of choice in women with Group B streptococcus infection if resistant to penicillin and analyze the proportion of Group B Streptococcus infection as a vaginal commensal. Methods: This is a hospital based prospective study comprising of 350 pregnant women at term gestation. Vaginal swabs as well as neonatal nasal swabs following delivery were collected under aseptic precautions and sent for culture and sensitivity. Results: Vaginal swab culture reports of 308 women out of 350 showed a growth. Candida albicans (23.8%), Enterococcus (5.6%), Escherichia coli (4.2%), MRSA (4.2%), Staphylococcus aureus (1.4%) and Group B Streptococcus (1.4%) were the organisms isolated. Penicillin is still the drug of choice for group B Streptococcal infection in antenatal women with Linezolid being the alternate drug of choice. None of the neonatal nasal swabs revealed any growth on culture and sensitivity. Conclusions: This study does not recommend routine screening for Group B Streptococcus in all pregnant women unless they have a positive history in previous pregnancies. Our study also revealed various other organisms which could be responsible for increasing the risk of maternal and neonatal morbidity.

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Endometrial stromal sarcoma (ESS) is a case malignancy and accounts for 0.2% of all uterine malignancies and 10% of all uterine sarcomas. In the present case, an unmarried 27-year-old woman presented with complaints of on and off episodes of pain in the lower abdomen. On examination, a diffuse oval mass was felt occupying the hypogastrium, iliac and lumbar regions and extending up to the umbilicus. CT scan impression was given as? Complex retroperitoneal mass? solid cystic ovarian mass with grade I right hydro nephrosis. On laparoscopy, a huge mass measuring approximately 10×10 cm was noted arising from the uterus. Laparoscopic myomectomy was done and the specimen was retrieved in a bag and the tissue was sent for histopathological examination. The postoperative clinical course was uneventful. The patient was advised to undergo oocyte cryopreservation following which she was advised hysterectomy with bilateral salphingo-oophorectomy. Pelvic radiation was advised thereafter. ESS is a rare malignant tumor, which on histopathological examination reveals sheets of cells and endometrial stromal cell differentiation. Hysterectomy with bilateral salpingo-oophorectomy is optimum initial therapy. Radiotherapy is chosen when the tumour is inadequately excised or the pelvic disease is locally recurrent. Low grade ESS is a rare form of uterine sarcoma usually seen between 40-60 years of age with limited available data regarding the clinical course and management. Early diagnosis and management is associated with a favourable prognosis and outcome.

Cervical cancer is the second most common cancer among women worldwide and metastasis to the spleen is a rare entity, with only few cases being reported.  The present case of a 55-year-old patient diagnosed with a splenic lesion 3 years following completion of chemotherapy combined with radiotherapy for advanced cervical cancer. The patient underwent diagnostic laparoscopy with splenectomy. The histopathological studies confirmed the presence of a metastatic squamous cell carcinoma (in a known case of treated cervical cancer). At one-year follow-up after splenectomy, the patient was free of any recurrent disease. Owing to its rarity and scant data available, detailed workup should be done whenever a solitary lesion in the spleen is detected on follow-up since splenectomy is the apt management which is instrumental in preventing further complications and improves the survival rates.